Evaluating a Global Mining & Metal Processing Company’s Liquidity, Hedging & Financing Strategies
July 14, 2021
Evaluating a Global Mining & Metal Processing Company’s Liquidity, Hedging & Financing StrategiesDownload Case Study
A global mining and metals processing company (the “Company”) was sued by certain minority shareholders after a restructuring diluted their investment. Experts from FTI Consulting were engaged by the Company to review the events that led to its restructuring.
Situation
The Company, leader in its market, faced a liquidity crisis at the end of 2018. The Company received financing from one of its largest shareholders (the “Shareholder”) to enhance its cash position. The Shareholder had a longstanding and extensive commercial relationship with the Company.
In 2019, the Company successfully restructured its balance sheet. As a result of the restructuring, the Shareholder became the Company’s majority owner. Following the restructuring, certain minority shareholders initiated litigation against the Company and its board of directors, alleging that the Company’s actions had ultimately led to the liquidity crisis and that the Shareholder unfairly benefitted from the restructuring.
Our Role
FTI Consulting experts were engaged to produce an expert report that analyzed the complex factors that eventually led to the restructuring.
We reviewed the Company’s industry, including the historical cyclicality of supply and demand and pricing for its key commodities, and its competitive position.
FTI Consulting experts reviewed the Company’s operational and financial performance, capital structure and financing agreements, which included bonds, working capital and trade finance facilities. As part of our analysis, we:
Benchmarked the Company’s financing facilities against comparable firms; Analyzed the cost and availability of alternative sources of financing; and Evaluated the effectiveness of the Company’s mitigating actions ahead of and during the liquidity crisis. Published
July 14, 2021
Key Contacts
Senior Managing Director, Leader of Securities, Commodities and Derivatives
Managing Director
Downloads Categories
Economic & Financial Consulting
Corporate Finance & Restructuring
Energy, Power & Products (EPP)


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The Reserve Bank of India maintains various instruments within its monetary policy to administer the Indian economy. It influences the prices of commodities, regulation of cash flow or money supply and many other factors of an economy.
Statutory liquidity ratio (SLR) is one of those financial instruments of RBI to maintain the solvency of banks. Read further to learn more about SLR.
The meaning of statutory liquidity ratio is a mandatory reserve requirement that Indian commercial banks must maintain. They must maintain it through liquid assets like cash, gold, bonds, PSU and RBI approved securities.
RBI Act mandates commercial banks to maintain a percentage of their net demand and time liabilities (NDTL) as SLR. RBI determines this percentage of SLR to control the expansion of a commercial bank.
A change in this ratio controls the ability of a financial institution to inject money into our economy. Therefore, RBI increases it in the time of inflation to restrict banks and NBFCs from providing loans.
Statutory Liquidity Ratio comprises 2 components as follows -
Assets that are readily convertible into cash are called liquid assets. Gold, cash reserves, government bonds, treasury bills, and RBI approved securities fall under this category. Besides, these include eligible securities under Market Stabilisation Schemes and Market Borrowing Programmes.
This is the aggregate balance of demand and time deposits of the public that a bank holds. Demand deposits are liabilities that a bank must pay on demand, comprising current and savings accounts, demand drafts etc. In contrast, time liabilities such as fixed deposits do not allow you to withdraw deposits immediately. These have a maturity period before which you cannot access the deposit.
RBI fulfils the following objectives through the statutory liquidity ratio in India.
Following are the institutions that RBI obligates to maintain a statutory liquidity ratio.
RBI levies an annual penalty of 3% over the bank rate for not maintaining liquid assets as SLR. Additionally, RBI charges a 5% fine if the bank fails to pay the penalty on the following working day.
RBI uses SLR as a reference rate to determine the base rate, which is the minimum lending rate. No bank can lend money below this rate to the public. It is fixed to ensure clarity regarding lending and borrowing in the credit market.
The reserve requirement of RBI restricts banks’ lending capacity. Therefore, banks usually increase their lending rate to control the demand.
Banks are required to reserve liquid assets, which include cash, gold and government bonds as SLR.
Banks need to have only cash reserves with the Reserve Bank of India to maintain CRR.
Financial institutions earn returns on assets parked as SLR.
In contrast, financial institutions do not earn returns on cash parked as CRR
SLR works as a tool to control the credit expansion of a bank.
Whereas, RBI uses CRR as a tool for controlling liquidity in banks.
Banks need to maintain the liquid assets by themselves.
On the other hand, banks must maintain CRR with the Reserve bank.


Overcoming the COVID-19 pandemic requires motivating the vast majority of Americans to be vaccinated. However, vaccination rates have become politically polarized and a substantial proportion of Republicans have remained vaccine-hesitant for months. Here, we explore how endorsements by party elites affect Republicans’ COVID-19 vaccine intentions and attitudes. In a pre-registered survey experiment (N = 1,480), we varied whether self-identified Republicans saw endorsements of the vaccine from prominent Republicans (including video of a speech by former President Donald Trump), from the Democratic party (including video of a speech by President Joseph Biden), or a neutral control condition including no endorsements. Unvaccinated Republicans who were exposed to the Republican elite endorsement reported 7.0% higher vaccination intentions than those who viewed the Democrat elite endorsement and 5.7% higher than those in the neutral control condition. These effects were statistically mediated by participants’ reports of how much they thought Republican politicians would want them to get vaccinated. We also found evidence of backlash effects against Democratic elites: Republicans who viewed the Democrat elite endorsement reported they would be significantly less likely to encourage others to vaccinate, compared with those who viewed the Republican elite endorsement or the neutral control. These results demonstrate the relative advantage of cues from Republican elites - and the risks of messaging from Democrats currently in power - for promoting vaccination among the largest vaccine-hesitant subgroup in the U.S.


Business Valuation
Business Valuation is the process of determining the economic value of a business or company. Business Valuation can be used to determine the fair value of a business for a variety of reasons, including sale value, establishing partner ownership and divorce proceedings.
If considering the acquisition or sale of a business, or portion thereof, a business valuation is a critical tool. A valuation can serve to bridge any discrepancy in the two parties' opinion of value and provide a reasonable starting point for discussion.
Our business valuation services include:


One of the main worries that job seekers have is that their chances of being hired by a company seem to decrease as they get older, especially in unskilled or low-skilled jobs. However, these people often have not only the same enthusiasm and motivation as younger people, but also possess valuable experience for any position.
At Pasqual Arnella we are very aware of this. We are a family business, and this year we are celebrating 130 years in the hands of our fourth generation. We would not have reached where we are today without having combined the experience of previous generations with the creativity of the newer ones.
For this reason, we have decided to access a line of aid* from the Catalan Employment Service, financed by the European Union and aimed at employing people aged 30 and over. This call includes permanent contracts and temporary contracts with a minimum duration of 12 months.
Thanks to this program, new employees have joined our team, reinforcing it with their experience and knowledge in different departments.
*This action is promoted and subsidised by the Servei Públic d’Ocupació de Catalunya and 100% financed by the European Social Fund as part of the European Union’s response to the COVID-19 pandemic.
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Staggering reports continue to mount showing the Illinois Department of Employment Security has been severely struggling for more than two years. The most recent audit conducted by the Illinois Auditor General, and released this week, shows similar findings of past reports which document mismanagement, dysfunction, and widespread fraud.
The two-year audit shows 26 findings of non-compliance, including failure to prepare monthly reconciliations and weaknesses in security over confidential information, among many other concerning findings. It was noted that the massive disorganization regarding unemployment claimants continues to prevent auditors from determining the amount of fraud within the pandemic unemployment assistance (PUA) program.
According to the Department, more than 424,887 claimants had received benefits totaling $8.16 billion by June 30, 2021. Auditors were unable to conduct further testing to see whether those claimants were actually entitled to these benefits.
Illinois is one of several states that borrowed from federal taxpayer funds to pay unemployment claims during the pandemic. The state racked up $4.5 billion in debt with interest. After failing to fill the deficit this spring, the state still owes $1.8 billion.


BILL NUMBER: SB 84
VETOED DATE: 10/11/2009
To the Members of the California State Senate:
I am returning Senate Bill 84 without my signature.
This bill is unnecessary. The state made many tough decisions to balance the budget for 2009-10, including reducing general-purpose funding for certain local educational agencies in order to ensure the continuation of the Quality Education Investment Act (QEIA) program, which provides targeted funding to improve academic achievement in the state's lowest performing schools. The intent in making these reductions was to direct available federal resources to compensate for the reductions. This bill would delay implementation of these reductions until comparable resources are identified, but does not provide a solution.
Instead, my Administration has identified $355 million in federal Fiscal Stabilization Funds that have been provided to the State forth purpose of restoring reductions in the 2008-09 fiscal year. As a result, California will have a plan to achieve the savings included in the 2009-10 Budget, while holding QEIA schools harmless. With this plan, it avoids the need for county offices of education to require school districts to submit revised budgets detailing the assumed revenue limit reduction that was previously anticipated.
My Administration will be working with the Legislature to implement this plan.
For these reason, I cannot sign this bill.
Sincerely,
Arnold Schwarzenegger


EU ETS 101 A beginner’s guide to the EU’s Emissions Trading System
Guide | 27 April 2022
The EU Emissions Trading System (EU ETS) is often referred to as a cornerstone of EU climate policy. It aims to reduce emissions by pricing greenhouse gas (GHG) pollution from the power, industry and aviation sectors.
This beginner’s guide to the EU ETS aims to build knowledge and understanding of Europe’s carbon market for civil society organisations who have little or no prior experience with EU climate policies, especially in countries neighbouring the EU. It provides introductory knowledge on how the EU ETS is designed and how it functions. Increased awareness should ultimately empower civil society to get involved in the ETS process and advocate for an effective and fair European carbon market.
The guide is a product of the Life ETX project, led by Carbon Market Watch, and has received funding from the LIFE programme of the European Union.
The guide is available in Serbian language.


In 2006, President Evo Morales passed the National Plan for Equality and Equal Opportunities for Persons with Disabilities. The plan included legal measures to ensure equal access for people with disabilities in the areas of health, education, economic rights, personal and social capacity-building, and institutional and organizational development. It also guaranteed increased financial support totaling $6 million annually, but the money never made it to the people to whom increased subsidies were promised.
Since taking office in 2005, Bolivian President Evo Morales had an increasingly tenuous relationship with the domestic media. On multiple occasions he accused newspapers of being the mouthpieces of the opposition, particularly if they criticized a state policy. The growing polarization between Morales’ Movement for Socialism Party (MAS) and the opposition parties was often reflected in the “media war” between state-owned news outlets and privately owned companies. Parties on both sides perpetuated the war by threatening journalists across the political spectrum.
On August 15, 2011, some 1000 indigenous peoples from the Isiboro Secure Park (known by its Spanish Acronym TIPNIS) in Bolivia began their protest march against a highway project through the park and their traditional homes. The 500km march from the Amazonian town of Trinidad to La Paz was organized by many indigenous leaders, including Fernando Vargas, president of TIPNIS Native Communities, and Rosario Barradas of the Conference of Indigenous People.
The 1977-1978 economic justice and human rights campaign in Bolivia stemmed from tensions that began with the 1952 Bolivian Revolution, which left the Nationalist Revolutionary Movement in power. This group implemented a nationalization of the tin mines, agrarian reforms, and universal franchises. These policies and reforms lasted until 1964, when a military coup led to the regime of General Barrientos. This regime clashed with miners and broke down worker power and cultivated the peasantry.
Throughout the 90s, Bolivia came under increasing pressure from the World Bank to privatize public goods in order to fulfill loan conditionality. In September 1999, in response to this pressure, the Bolivian government auctioned off the municipal water system ‘SEMAPA’ of Cochabamba, a city of 800,000 residents. When the auction drew only one bidder, the government signed water resources over in a 40-year concession to Aguas del Tunari, a foreign-led consortium of private investors dominated by the Bechtel Corporation.


The University of Waikato
2nd Floor, FG-Link
Gate 8
Hillcrest Road
Hamilton
NEW ZEALAND
People and organisations are increasingly choosing to store their valuable data in the Cloud environment. But there is currently no way of knowing where your data goes. Who has access to it, how will you know if someone tries to copy one of your most precious assets and - most importantly - what can you do about it?
The Cyber Security Researchers of Waikato (CROW) aim to return the control of data to you, the data owner, by focusing on research addressing data security from a user-centric perspective.
In 2013, CROW became the first cyber security lab established in a New Zealand educational institution as part of the Faculty of Computing and Mathematical Sciences at the University of Waikato. In the same year we launched New Zealand’s first Master of Cyber Security degree. They also host the annual New Zealand Cyber Security Challenge while the STRATUS research group holds an annual forum in Wellington. The STRATUS Forum aims to engage and familiarise New Zealand industry partners and end-users with the services and products being developed by STRATUS, a six-year, $12.2 million cyber security project, funded by the Ministry of Business, Innovation, and Employment (MBIE) and led by CROW’s Assoc Prof. Ryan Ko.


Question 1: Recovery from COVID-19 disruption of cancer care in Ontario
An Ontario Liberal Government will invest $1 billion over two years to clear the surgical and diagnostic backlog. We will clear the backlog by investing in additional capacity – empowering hospitals to operate significantly above pre-pandemic volumes and expand operating room, MRI and CT operations – including into evenings and weekends. We will also establish and publish maximum wait times for all surgeries and return to pre-pandemic wait times for those above the maximum by the end of 2022. This includes cancer surgeries. We will create a centralized electronic surgical waitlist – requiring all specialists to use e-referrals to shorten wait times and maximize scheduling efficiency. Unlike Conservatives, Ontario Liberals believe in public health care. We’ll support the creation of not-for-profit surgery centres managed by local hospitals to more sustainably maintain higher surgical volumes.
Question 2: The expansion of lung cancer screening
One of the lessons from COVID is the fragility of our healthcare system and the sometimes lack of coordination between various parts of the “system”. An Ontario Liberal Government is committed to making healthcare more accessible to all Ontarians, in all regions of the province and from all socio-economic groups. We will work with key stakeholders to review the existing provision of critical services, such as lung cancer screening, and will move rapidly to eliminate any barriers to access for those services. This includes a commitment to a new cancer centre in Brampton. We will invest in engaging preventative health initiatives that teach people about their health, including raising awareness about the signs of stroke and concussion safety. We will also charge a fee to the tobacco industry, making back the $44 million spent on efforts to prevent or get people to quit smoking under Smoke Free Ontario.
Question 3: If elected to government, will your party allow women to self-refer for a mammogram, starting at age 40?
An Ontario Liberal Government will be guided by evidence in making any healthcare related decisions. We will commit to undertake a full and comprehensive review of the medical evidence – led by healthcare professionals and including cancer organizations – to determine any changes to cancer screening.


1 Money in motion
When Typhoon Yolanda (Haiyan), the strongest typhoon to ever make landfall, cut through the central Philippines last November 8, 2013, it caused damage of unprecedented proportions. The most recent National Disaster Risk Reduction Management Council (NDRRMC) estimates place the death toll at 5,235 and damage of P22 billion, making it the third costliest typhoon in the Philippines.
If there is a silver lining to this disaster, however, it is the overwhelming response of the international community to the disaster. Foreign aid has reached P19.5 billion as of November 20, 2013, according to the UNOCHA Financial Tracking Service. However, concerns arise regarding how these aid flows are being managed and delivered, and it’s useful to take a look at how aid money is flowing though the system, which we can visualize using data from the UNOCHA-FTS: 2 Developed country aid
The major donors include: the United Kingdom (P5.9B), the United States (P1.8B), Private Interests (P1.5B), Australia (P1.25B), the UN Central Emergency Response Fund (P1.1B), along with several European and Middle Eastern countries.
3 Malversation blues
The largest aid channels are UN agencies, Red Cross organizations, the Philippine government, and Non-Government Organizations.
Many are worried that these aid contributions, when coursed through the government, won’t reach intended beneficiaries. The Philippine government has received a significant amount - around P1.6 billion or 8% of total aid provided - but not a majority of foreign aid. This has come mainly from the Asian Development Bank and the United Arab Emirates. However, the largest yet undisclosed “Various Recipients” category may change these facts.
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4 Explore the data
If you’d like to explore the data in more granular data, you can take a look at this excellent compilation by The Guardian’s Data blog. It’s great because it makes the distinction between uncommitted pledges (non-binding announcements to deliver aid), and actual funding (legal or fulfilled aid commitments):
Data and computation requests can be made through the contact form or by commenting below.
References The Guardian. http://www.theguardian.com/news/datablog/interactive/2013/nov/20/aid-philippines-typhoon-haiyan-who-gives-what. Citation
@online{palanca2013, author = {TJ Palanca}, editor = {}, title = {On {Yolanda/Haiyan} {Foreign} {Aid}}, date = {2013-11-23}, url = {https://tjpalanca.com/content/blog/2013-11-23-yolanda-haiyan-foreign-aid-who-is-giving-what-and-to-whom/yolanda-haiyan-foreign-aid-who-is-giving-what-and-to-whom.html}, langid = {en}}


The South African lawmakers are pushing for the National Credit Amendment (NCA) Act, which seeks to assist thousands of residents with debts to relieve their financial situation, BusinessTech said. However, ENews Channel Africa (eNCA) noted that the so-called debt relief bill is seen as a “double-edged sword” for South Africans.
In achieving its goal to relieve citizens living with debt, the NCA offers the chance to
“have their debt suspended in part of in full for up to 24 months.” To avail of this, citizens need to send in their applications. For successful applicants, the bill opens the possibility of the debt being “extinguished” if the financial situation of the individual does not improve.
Qualified individuals include those who have unsecured loans of R50,000 and under. The debt must also be acquired through
“unsecured credit agreements, unsecured short term credit transactions or unsecured credit facilities only.” Moreover, the individual must have an income of R7,500 per month over the past six months.
While this may be a good thing for indebted South Africans, the implementation of the NCA can work to their disadvantage. To put it into perspective, eNCA cited FinMark Trust report which revealed that
“around a third of the population rely on loans for necessities like food.”
With the implementation of NCA, SA’s major banks face
“they had or would cut back on lending to those low-income customers who might qualify for relief in the future.”
Some of the banks that had or would reduce its lending to qualified by low-incomes borrowers include African Bank, Absa, FirstRand and Capitec.
Aside from the decreased lending activity toward the group, experts said that they may be consequences when applying for the write-off. Wayne McCurrie from FNB Wealth warned that applicants risk the possibility of not getting credit from the formal sector again.


Professor Susan Rossell is a cognitive neuropsychologist at Swinburne’s Centre for Mental Health, she also holds adjunct positions at Monash Alfred Psychiatry Research Centre and at St Vincent's Health. Professor Rossell’s research focuses on understanding the cognitive and neurobiological processes involved in psychosis and related disorders. She has published extensively and received both the International and European award for Young Investigator into Schizophrenia Research. Susan Rossell latest research reveals the long-terms effects from the COVID-19 pandemic are similar to the aftermath of traumatic events such as war a natural disaster.
She discusses the long-terms impacts from lockdown with specialist journalist Hayley McAdam on 3KND's "ON TRACK". Professor Rossell studied at the University of Manchester, the Institute of Psychiatry (part of King's College London) and Oxford University. She gained extensive experience in neuroimaging while undertaking a position at London’s world-renowned Functional Imaging Lab. In 2000 Professor Rossell was awarded a prestigious International Welcome Post-Doctoral Fellowship during which she spent time at Macquarie University. Before joining Swinburne, she also held roles as Head of the Cognitive Neuropsychiatry Department at the Mental Health Research Institute of Victoria and at Monash Alfred Psychiatry Research Centre.


Resolute Mining Ltd has presented its consolidated life of mine plan for the Syama gold mine in Mali and the Mako gold mine in Senegal.
Highlights Life of mine (LOM) plan updated to reflect an average annual production of 370 000 oz over the five years to 2026 at an average AISC of US$1191/oz. Total LOM total gold production 3.5 million oz at an average AISC of US$1110/oz to 2033. Syama gold production: Averages 243 000 oz/yr at an average AISC of US$993/oz over the current 12 year mine life to 2033. Syama oxide production extended from 2023 until 2026 reflecting exploration success increasing satellite resource by 90%. Tabakoroni sulfides expected to commence in 2026 with an estimated gold production of 664 000 oz over an eight year mine life. Mako LOM gold production of 607 000 oz, remains unchanged at an updated average AISC of US$1071/oz over the remaining six-year mine life. Exploration continues to be a key focus at both Syama and Mako and is expected to extend LOM production profiles at both operations.
Resolute’s CEO, Stuart Gale, commented: “Our latest LOM plan reflect an improved production profile over the current 12-year mine life at Syama incorporating the successful exploration campaigns which have extended oxide production for an additional two years together with exceptional drilling results at Tabakoroni. This allows us to defer the development of the Tabakoroni sulfide mine as we continue to assess and optimise the plan for the development of this resource.
“Syama has a significant gold endowment and there is still a great deal of exploration to be undertaken in this area. We remain very confident that the Syama operations will continue developing and extending beyond what we have published today.
“In addition, we remain focused on identifying further extension and development opportunities at Mako in Senegal, where we also expect to extend our mining activities beyond the current mine life.”
Syama LOM plan
Syama is a large-scale operation currently comprising an underground mine and opencast satellite mines providing ore to two separate processing circuits: a 2.4 million tpy sulgide processing circuit and a 1.5 million tpy oxide processing circuit.
A pre-feasibility study for an underground mine at Tabakoroni was completed in 2020. It is intended that Tabakoroni sulfides will sustain Syama’s annual production between 250 – 300 000 oz until 2030, as oxide operations cease. Exploration success at Tabakoroni has resulted in reserves increasing to 5 million t at 4.7 g/t for 0.77 million oz while resources have increased by 40% to 9.2 million t at 4.4 g/t for 1.35 million oz . In light of the ongoing exploration success, Resolute continues to optimise plans for the development of the Tabakoroni sulfide.
The updated Syama LOM reflects:
Sulfide gold production has been revised to 145 000 oz in 2022 (announced as part of Resolute’s 2022 guidance released in January 2022) due to the deferral of the planned sulfide circuit shutdown from late 2021 to February 2022. Throughput and recovery improvements are expected following this shutdown, together with a number of other initiatives, including the installation of the cleaner cells and debottlenecking of the fluid bed cyclone. As a result of these initiatives, forecast gold production is expected to step up to an average 177 000 oz between 2023 and 2030. Operation of the underground mine, based on the current LOM, extends to 2033 and with further exploration, is expected to continue beyond this timeframe. LOM recoveries have been adjusted to 81% reflecting a marginal improvement on current performance. Exploration and resource conversion is likely to further extend mine life further. Syama oxide mining and processing has been extended to 2024 and 2026 respectively, reflecting a 90% increase in the mineral resource for the Syama satellite deposits, published in the 2021 ore reserves and mineral resource statement. Opencast grades have marginally reduced annual production to approximately 76 000 oz/yr between 2022 and 2024. Resolute continues to evaluate opportunities to extend opencast mining inventory at Syama. Development of the Tabakoroni sulfide mine at an estimated cost of US$80 – US$100 million has been deferred to 2026, due to the extension of oxide production. Based on the current schedule development is expected to commence late in 2024 with Tabakoroni sustaining Syama sulfide production between 250 000 – 300 000 oz/yr from 2026. The Tabakoroni sulfide mine is currently expected to have an eight year life. Minimal project capital is required over the remaining Syama LOM aside from the capital required to establish Tabakoroni sulfides. Between 2021 and 2029 Syama’s average sustaining capital is expected to be approximately IS$20 million/yr. Updated Mako LOM plan
The Mako LOM production of 607 000 oz remains largely unchanged from the April 2021 LOM. AISC/oz is expected to be approximately 12% higher over the LOM. This increase reflects updated modelling of the cost base in the latter years of the mine life, where mining extends deeper into the pit and the haulage costs increase. In addition, the change in ore blend over time is expected to lead to increased processing costs.
Resolute notes that the above AISC/oz assumes the company is able to extend the tax exoneration it has received since the commencement of mining, for the remainder of the Mako LOM. As outlined in the company’s 4E preliminary financial statements, the company is currently in discussions with the Senegalese authorities regarding the extension of the tax exoneration from 5 – 7 years.
If the tax exoneration is not extended beyond five years, it is estimated that the LOM AISC/oz would increase from US$1071 – US$1145/oz, resulting from of the additional duties imposed. The company is firmly of the view that it has satisfied all relevant grounds for the exoneration extension to be granted, specifically the two year extension to the mine life.
Read the article online at: https://www.globalminingreview.com/mining/07032022/resolute-mining-provides-life-of-mine-production-update/


A growing number of complex, expensive medications are entering the market. At the same time, health insurance companies, also called payer, are increasingly relying on utilization management to control healthcare costs by influencing patient care decisions. Common utilization management tools include prior authorizations, step therapy, predeterminations, and preauthorizations.
Prior authorizations (PAs or prior auths) are among the most common and burdensome cost management tools, requiring providers to obtain approval before insurance companies pay for costly medications or expensive services.2 The prior authorization process delays care, burdens providers, and ultimately increases U.S. healthcare costs.1 Based on a study published in 2021, payers, manufacturers, physicians, and patients spend $93.3 billion annually on implementing, contesting, and navigating utilization management strategies.4
Understanding utilization management is crucial for all parties involved in the prior authorization process as U.S.healthcare regulations become more complex and medication costs rise. Let’s explore utilization management, its components, and its future.
What is utilization management?
Utilization management (UM) is managed care’s approach to controlling the cost of healthcare benefits by assessing each service’s medical necessity.3 The term managed care is sometimes confused with health insurance. However, managed care is a distinct business model emphasizing value-based healthcare.6 Managed care plans come in various forms, such as health maintenance organizations (HMOs) and preferred provider organizations (PPOs).
According to the Institute of Medicine (IOM), UM is defined as “
a set of techniques used by or on behalf of purchasers of health care benefits to manage health care costs by influencing patient care decision-making through case-by-case assessments of the appropriateness of care prior to its provision.“5 This article focuses on elements of UM related to patients’ access to medications. However, utilization management is a value-based approach for all medical services and care coordination, including medical procedures, behavioral health, inpatient care, and emergency services.
Medication UM tools include:
Step therapyrequires patients to try a lower-cost drug before “stepping up” to a more expensive drug. The approval process for the more expensive treatment can take weeks or months. Managed care believes step therapy reduces costs. Prior authorizationrequires providers to request approval before a payer will cover medication. Patients may wait for days for approval. Managed care believes prior auths improve safety and reduce the cost of care. Quantity limitscontrol over how often or the amount you can get filled at once. Patients are required to exert additional effort in obtaining their medications, leading to potential medication non-adherence. Managed care believes quantity limits reduce waste and costs. Mandatory generic substitutionrequires patients to use generic medications when they are available. Patients who want the branded version must pay the difference. Generic substitution policies typically apply to a plan’s entire formulary, not specific drugs. According to managed care, the policy reduces costs. What is the difference between predetermination and prior authorization?
A common source of confusion among patients and providers is the difference between predetermination and prior authorization. While prior authorizations are required for patients to receive access to expensive medications, predeterminations are
voluntary utilization management reviews of healthcare services.
The predetermination process is unnecessary for services and drugs on the prior authorization list. Still, the predetermination process can lower the number of denials of coverage for a treatment plan. However, a predetermination does not mean that members’ benefit plans will cover the services but can help determine whether a procedure is a non-covered service.
What is the purpose of utilization management?
Regardless of the type of utilization management tool, the purpose of utilization management is to ensure members of managed care plans receive
high-quality, cost-efficient care. UM also prevents the following: denials of coverage unnecessary expenses regulatory noncompliance Which medications require utilization management?
Medications associated with utilization management are those with the following characteristics:
Safety concerns, including drug interactions Affordable alternatives are available Off-label potential Misuse or abuse potential Distribution restrictions or special handling requirements Benefits across multiple categories (e.g., medical and cosmetic) Is utilization management effective?
According to the American Medical Association (AMA), appropriate medical care must follow evidence-based guidelines developed by national medical specialty societies and remain consistent across all payers and health plans. Currently, a standard national definition of medical necessity doesn’t exist among payers, creating confusion for providers and patients.
As medicine becomes more personalized, medical necessity for one patient may not align with another patient’s similar yet distinct condition. Consequently, UM will become increasingly challenging and require medical professionals from various specialties for care coordination to ensure high-quality care for every patient. Coordination of care is particularly complicated due to managed care’s utilization management tools, requiring providers and patients to waste valuable time waiting for payer decisions.
Though UM is supposed to prevent unnecessary costs and ensure current standards are based upon real-world evidence, the tools used for UM often present a barrier to an optimal level of patient care. UM tools can result in patient frustration, leading to the potential for underutilization of health care services and risks to patient’s health. Within UM, utilization reviews aim to improve standards of care by evaluating patient outcomes.
What is a utilization review? What is a utilization review?
Utilization reviews (URs) involve a team of health care professionals who help identify opportunities for improving care processes and outcomes while reducing costs. UR differs from UM, but UR can affect UM by identifying ineffective quality controls or cost-saving strategies. During a UR, a utilization review nurse generally examines health care services, treatments, or medications on behalf of the payer, determining if the care provided is appropriate and a “medical necessity.” Most hospital systems use Interqual and Milliman, an evidence-based clinical decision system, to assist with determining medical necessity.
However, many payers have failed to establish standards of care or do not integrate current clinical guidelines into their UR process. When there is disagreement about coverage between the doctor and payer, a peer to peer review occurs. In a peer to peer review, a patient’s doctor justifies a patient’s medical service or prescription to the insurance company’s medical director. Often, these interactions occur when a payer denies a claim according to its internal policies.
There are three types of utilization reviews:
Prospective review:determines whether services or scheduled procedures are medically necessary before admission. Concurrent review:evaluates medical necessity decisions during hospitalization. Retrospective review:examines coverage after treatment. These reviews are all also called post-service utilization management reviews.
Predictive data analytics and artificial intelligence (AI) are increasingly used to streamline the process of utilization management and utilization review. AI can assist in determining the appropriateness of care or medical necessity. At the same time, only coverage requests AI cannot automatically approve are sent to UM reviewers, thus reducing the manual burden.
What is a Drug Utilization Review (DUR)?
A drug utilization review (DUR) examines the prescribing, dispensing, and use of medications by practitioners and pharmacists. The purpose of DUR is to ensure drugs are used appropriately, safely, and effectively. Standard prescribing guidelines are compared against a patient’s or a population’s prescription history.
Similar to utilization management reviews, DURs are classified into the following three different categories:
1.
Prospective drug utilization review: enables pharmacists to resolve problems before medications are dispensed by evaluating a patient’s planned drug therapy.
2.
Concurrent drug utilization review: allows pharmacists to detect potential issues and intervene in areas such as drug-drug interactions, duplicate therapies, overuse or underuse, and excessive or insufficient doses during a patient’s duration of care.
3.
Retrospective drug utilization review: aims to detect patterns in prescribing, dispensing, or administering drugs. By analyzing patterns of medication use, standards and target interventions can be developed. What is the future of utilization management?
Pharmacists play an essential role in utilization management and the prior authorization process. Clinical or industry pharmacists with prior authorization specialist certifications are valuable players in utilization management due to their subject matter expertise. The Academy of Managed Care Pharmacy (AMCP) conducted a multi-stakeholder forum in June 2019 to identify processes for optimizing prior auth and step therapy. The AMCP emphasized the benefits of pharmacist-initiated prior auths as part of their efforts to improve the process. The benefits of pharmacist-initiated PAs include the following:
Provide the payer with prescription histories to expedite the prior auth process. Access to the patient’s electronic health record (EHR) to obtain diagnostic or laboratory information. Access to patients during evenings and weekends.
Engaging pharmacists in the prior auth process is only one tactic identified by the ACMP to improve the utilization management process. The U.S. healthcare system will continue to increasingly employ utilization management processes, and understanding how to navigate them is vital for all healthcare providers. To learn more about utilization management and the benefits of a prior authorization specialist certification, visit the National Board of Prior Authorization Specialists.
References AMCP Partnership Forum: Optimizing Prior Authorization for Appropriate Medication Selection. J Manag Care Spec Pharm. 2020;26(1):55-62. doi:10.18553/jmcp.2020.26.1.55. Carlisle RP, Flint ND, Hopkins ZH, Eliason MJ, Duffin KC, Secrest AM. Administrative Burden and Costs of Prior Authorizations in a Dermatology Department. JAMA Dermatol. 2020;156(10):1074-1078. doi:10.1001/jamadermatol.2020.1852. Giardino AP, Wadhwa R. Utilization Management. In: StatPearls [Internet]. StatPearls Publishing; 2022. Howell S, Yin PT, Robinson JC. Quantifying The Economic Burden Of Drug Utilization Management On Payers, Manufacturers, Physicians, And Patients. Health Aff . 2021;40(8):1206-1214. doi:10.1377/hlthaff.2021.00036. Institute of Medicine (US) Committee on Utilization Management by Third Parties, Gray BH, Field MJ. Utilization Management: Introduction and Definitions. National Academies Press (US); 1989. Accessed August 23, 2022. https://www.ncbi.nlm.nih.gov/books/NBK234995/ Teisberg E, Wallace S, O’Hara S. Defining and Implementing Value-Based Health Care: A Strategic Framework. Acad Med. 2020;95(5):682-685. doi:10.1097/ACM.0000000000003122.


Sequestration of latent TGF-β binding protein 1 into CADASIL-related Notch3-ECD deposits
Acta Neuropathol Commun. 2014 Aug 13;2(1):96. [Epub ahead of print]
Authors/Editors: Kast J, Hanecker P, Beaufort N, Giese A, Joutel A, Dichgans M, Opherk C, Haffner C. Publication Date: 2014 Abstract
INTRODUCTION:
Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) represents the most common hereditary form of cerebral small vessel disease characterized by early-onset stroke and premature dementia. It is caused by mutations in the transmembrane receptor Notch3, which promote the aggregation and accumulation of the Notch3 extracellular domain (Notch3-ECD) within blood vessel walls. This process is believed to mediate the abnormal recruitment and dysregulation of additional factors including extracellular matrix (ECM) proteins resulting in brain vessel dysfunction. Based on recent evidence indicating a role for the transforming growth factor-β (TGF-β) pathway in sporadic and familial small vessel disease we studied fibronectin, fibrillin-1 and latent TGF-β binding protein 1 (LTBP-1), three ECM constituents involved in the regulation of TGF-β bioavailability, in post-mortem brain tissue from CADASIL patients and control subjects.
RESULTS:
Fibronectin and fibrillin-1 were found to be enriched in CADASIL vessels without co-localizing with Notch3-ECD deposits, likely as a result of fibrotic processes secondary to aggregate formation. In contrast, LTBP-1 showed both an accumulation and a striking co-localization with Notch3-ECD deposits suggesting specific recruitment into aggregates. We also detected increased levels of the TGF-β prodomain (also known as latency-associated peptide, LAP) indicating dysregulation of the TGF-β pathway in CADASIL development. In vitro analyses revealed a direct interaction between LTBP-1 and Notch3-ECD and demonstrated a specific co-aggregation of LTBP-1 with mutant Notch3. CONCLUSION: We propose LTBP-1 as a novel component of Notch3-ECD deposits and suggest its involvement in pathological processes triggered by Notch3-ECD aggregation.


These field notes capture the experiences, ideas and insights shared during a workshop on the interrelated goals of ending poverty and tackling climate change. The virtual session was held on May 6, 2021, during the Cities Reducing Poverty (now, Communities Ending Poverty) annual gathering, and attracted 127 participants from across Canada and around the world.
Take your learning further:
Watch the webinar: Climate Change and Ending Poverty Read the article Exploring the Intersections of Climate Change and Poverty


Individuals insured by some large life insurance policies may face a surprisingly high risk of death due to non-medical causes such as accidents or suicides.
Milliman Inc., Seattle, has published that finding in a summary of results from the Milliman Industry Mortality Study and Analysis (MIMSA).
The study includes mortality and lapse information from 29 insurers, and it includes data on 1.6 million deaths and 8.1 million lapses that occurred from 2000 to 2009.
Overall mortality was only 87% of the expected rate, but there was a large range of results from company to company for both mortality and lapse, Milliman says.


The insular shelf south of St. Thomas and St. John, in the U.S. Virgin Islands (USVI) is an expansive geomorphologic feature with extensive mesophotic coral reefs occurring at 30 to 150 meter depths. These mesophotic reefs are part of a broader coral reef community in the U.S. Caribbean that provide a wide range of ecosystem goods and services estimated to provide $187 million per year (in 2007 US dollars) to local communities. While these reefs provide great economic value to local communities, they are increasingly under threat from multiple human-caused stressors, making it critical for the USVI and Puerto Rico jurisdictions to find ways to preserve and sustainably manage them. Ideally, the first step in any marine management process is to comprehensively map and inventory the location of coral reef resources. The habitat map products provided in this report represent the first complete habitat map for the insular shelf south of St. Thomas and St. John. These products also represent the culmination of an extensive seafloor mapping campaign conducted by NOAA’s National Centers for Coastal Ocean Science (NCCOS) in collaboration with regional partners.
In total, 652 km2 of seafloor were characterized on the insular shelf south of St. Thomas and St. John. These habitat map products are ‘pixel-based,’ developed from 11×11 meter resolution raster images and mathematical modeling techniques called boosted regression and classification trees. These modeling techniques generate continuous spatial predictions by finding relationships between the geographic distribution of habitats (extracted from 1,005 underwater videos) and environmental conditions that may be influencing or correlated with these distributions (extracted from 20 raster images describing the oceanography, geography, and seafloor topography of the area). The final habitat map products describe the probability of occurrence and associated precision for four individual substrata (i.e., ‘Coral Reef’, ‘Pavement’, ‘Rhodoliths’, and ‘Sand’) and two biological cover types (i.e., ‘Live Hard Coral’ and ‘Live Soft Coral’). These six layers were also combined to create a single, composite benthic map with five habitat classes including: ‘Coral reef colonized with live coral’, ‘Rhodoliths with macroalgae’, ‘Bare sand’, ‘Rhodoliths with macroalgae and bare sand’, and ‘Pavement colonized with live coral.’ The performance and thematic accuracy of these products were evaluated using an independent set of underwater videos (n=348). The performance of the habitat models was considered to be good to outstanding based on four quantitative metrics, including percent deviance explained (x̄ =37.4% ±16.2 SE), area under the receiver operating characteristic curve (x̄ =0.86 ±0.05 SE), mean error (x̄ =-0.04 ±0.03 SE) and root mean square error (x̄ =0.33 ±0.04 SE). The overall accuracy and tau value for the composite habitat map was high at 85.6% and 0.82 ±0.05, respectively.
‘Coral Reef colonized with live coral’ was the most abundant habitat type on the insular shelf, comprising 34.3% (223.6 km2) of the area. It was dominant throughout the Virgin Passage, Hind Bank, along the upper shelf of French Cap Bank, and along ridge features south of St. Thomas. ‘Bare sand’ was often found around the edges of these coral reef structures, particularly on the eastern portion of the insular shelf. Linear patches of bare sand were also common in the middle of the insular shelf between Hind Bank and Frenchcap Bank. Interestingly, these patches were fairly regularly spaced, and commonly oriented in the north-south direction, suggesting they were formed by consistent bottom currents in the area. ‘Rhodoliths with macroalgae’ was the second most abundant habitat, comprising 30.2% (196.8 km2) of the insular shelf. This habitat was more common in deeper depths (greater than approximately 45 m), especially near Frenchcap Bank, Tampo Bank, and west of El Seco. ‘Rhodoliths with macrolagae’ often transitioned into ‘Rhodoliths with macroalgae and bare sand’ at this depth threshold. This transition was particular sharp south of Frenchcap Cay and the Midshelf Reef. Lastly, ‘Pavement colonized with Live Coral’ was the least abundant habitat type, comprising 4.8% (31.3 km2) of the area. It occurred primarily in the southeast region on the insular shelf. As these complex spatial patterns suggest, seafloor habitats vary widely across the insular shelf south of St. Thomas and St. John.
The products described here capture these complex patterns and translate them into maps that can be used to plan for potential activities both onshore nearby islands and offshore on the insular shelf. They can also be integrated with other spatially coincident datasets collected by NCCOS and regional partners, including underwater videos collected using remotely operated vehicles and acoustic information describing the size, abundance and distribution of fish. The best way to access and use these products is through geographic information systems (GIS) software that allows users to zoom in and create custom maps. These GIS-ready layers are archived at NOAA’s National Centers for Environmental Information (NCEI) and are freely available for viewing and download from the following project page: https://coastalscience.noaa.gov/project/habitat-map-insular-shelf-south-of-st-thomas-st-john/. For users that do not have GIS software or expertise, these map products are accessible as print-ready maps at the end of this report, and through an online map viewer linked to the above project page.


Educational consulting can be as simple as having an expert discussing an appropriate educational plan or sit in on a school meeting as an advocate. It also includes reading, reviewing and interpreting evaluations; helping to establish next steps, timelines and schedules; and explaining Individualized Educational Programs (IEP), Response to Intervention plans (RTI) and 504 plans, which ensure that a child with a disability receives accommodations that result in academic success. By establishing a positive and productive relationship between school and family, Dana or a specialized team member serves as an educational consultant who sets up students for success. Dana is experienced in effectively communicating with teachers and administrators, and she can assist in crafting concise emails and letters that produce results.
Additionally, Dana can support parents when they receive information about their child from medical professionals. Dana communicates regularly with several pediatric neuropsychologists and is skilled in pulling key concepts and takeaways from reports that can otherwise leave parents overwhelmed. These conclusions and Dana's expertise can help determine next steps, a positive approach and strategies for navigating the school system.
If you would like more information about a private educational consulting session or a package of sessions, contact Dana at 847-736-9266 or danastein@danasteinacademics.com.
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International law differs from traditional common law principles in several respects. Foremost is that international law predominantly focuses on governing sovereign states’ actions. In the United States, many laws are designed to govern the behavior of “persons,” including corporations and other legal “persons.” In the international law forum, the citizens of the nations are impacted by but rarely governed directly by international law principles.
Some of the challenges in the administration of international law include the decentralized nature of the legal functions. This is due to two main factors. First, the need to maintain the sovereignty of the nations subject to the law necessitates adequately dispersing the power. The concentration of power will threaten the independence of the nations subjected. Most recently, the decision by the UK to leave the EU was driven, in part, by this issue. The second is that the nature of international law tends to lend itself to specific policy issues developed by various treaties and NGOs, which have both narrow scope and enforcement capability.
The structure lends itself to a horizontal rather than vertical span of influence, resulting in both limited effectiveness in enforcement and a sense of collective responsibility by both groups of nation-states and collective responsibility by their citizens.
A violation of international law often results in collective punishment for the citizenry, including the impacts of war, trade sanctions, taxation or reparations, and other remedies. While international law and tribunals have focused since World War II on identifying and prosecuting individuals, rather than entire nations, for violations of international law, especially violations of human rights, this approach remains the exception rather than the rule.
To maintain independence and sovereignty, states must voluntarily subject themselves to international law and its enforcement. Generally accomplished through treaties, this also involves internalizing the treaty provisions and laws into national laws. Integrating many aspects of the Geneva Convention into the United States Uniform Code of Military Justice is one example of this integration. Many international law conflicts arise where this integration does not exist or is not enforced.
For thousands of years, customs and traditions of interaction between nation-states governed their behavior and served as the basis for modern international law. Since the First World War and the advent of modern communications and transportation, the frequency and intensity of these international interactions have increased. Treaties and legal approaches have replaced the traditional use of force to govern their interactions.
This extends to interchange, which is inherent in most international law. Generally, a bad actor state was viewed as violating all treaty members, not just the singularly aggrieved party. The nature of these laws and agreements was to preserve human rights, self-determination, and environmental protection, in addition to free trade. Thus, a violation by a nation-state was a violation against all parties.
The challenge is that international law enforcement rests with the implementation of sanctions or force. Both significantly impact the people of the offending state, regardless of their guilt or innocence. While the goal is to preserve the common good, the ability to do so is limited.


Abstract
Tumor-induced immune suppression can permit tumor cells to escape host immune resistance. To elucidate host factors contributing to the poor response of adoptively transferred tumor-reactive cytotoxic T lymphocytes (CTLs), we used a systemic model of murine acute myeloid leukemia (AML). AML progression resulted in a progressive regulatory T-cell (Treg) accumulation in disease sites. The adoptive transfer of in vitro - generated, potently lytic anti - AML-reactive CTLs failed to reduce disease burden or extend survival. Compared with non - AML-bearing hosts, transferred CTLs had reduced proliferation in AML sites of metastases. Treg depletion by a brief course of interleukin-2 diphtheria toxin (IL-2DT) transiently reduced AML disease burden but did not permit long-term survival. In contrast, IL-2DT prevented anti-AML CTL hypoproliferation, increased the number of transferred CTLs at AML disease sites, reduced AML tumor burden, and resulted in long-term survivors that sustained an anti-AML memory response. These data demonstrated that Tregs present at AML disease sites suppress adoptively transferred CTL proliferation, limiting their in vivo expansion, and Treg depletion before CTL transfer can result in therapeutic efficacy in settings of substantial preexisting tumor burden in which antitumor reactive CTL infusion alone has proven ineffective.


For many gaming enthusiasts and sports fans around the world, sports betting is synonymous with the game itself. It can enliven the doldrums of what feels like a long off-season, add an exclamation mark to a team’s biggest game, and oftentimes, is motivated by the love of a sport as much as the potential profits.
Over the past few years, it’s become clear that Canadian consumers are looking for a regulated space to participate in online casino games and single-sport betting. In response to this steady demand, Ontario legalized online gaming in the Spring of 2022. Since then, numerous companies have entered the booming industry, including the homegrown online casino and sportsbook platform, NorthStar Bets from NorthStar Gaming. The made-in-Ontario platform offers a localized experience while ensuring players’ entertainment dollars remain in the province.
NorthStar Bets aims to educate consumers and provide engaging content for experienced bettors, casual bettors, and those who are simply curious about the space. While on the NorthStar Bets platform, gaming enthusiasts have access to the most relevant and timely stats, analysis, and commentary thanks to the platform’s robust insights section.
Consumers enjoy a unique online gaming experience with access to a comprehensive sportsbook and the most popular online casino games, including live dealer blackjack, roulette, baccarat, and a variety of cumulative jackpot virtual slot machines.
“The NorthStar experience is truly unique, it’s content-driven and packed with news, insights and analysis all within a single platform. This is an experience that gaming enthusiasts have been requesting for many years and we’re excited to get NorthStar Bets in the hands of consumers,” said Michael Moskowitz, Chief Executive Officer and a founding partner of NorthStar Gaming.
NorthStar’s Senior NHL Insider Chris Johnston headlines the NorthStar Bets content team that provides insights and analysis for consumers. Chris is considered one of North America’s top hockey insiders and leads NorthStar Bets coverage of the Toronto Maple Leafs and the NHL at large.
“This new era of single-sports betting is bringing gaming enthusiasts and sports fans together and igniting the passion Ontarians have always had for our home teams. NorthStar Bets is designed with a fans-first approach and provides consumers with relevant, timely, and localized content that highlights favourite and home teams,” added Moskowitz.
Based on early consumer interest and demand, it’s clear Ontario sports fans are eager to participate in the newly launched single-sports marketplace. With so much excitement reverberating throughout the industry, companies like NorthStar that are delivering real-time sports news, industry insights, and analysis will not only thrive in a growing market, but they will also allow Ontario’s sports fans to thrive with them.
It’s these elements that are positioning NorthStar as a convergence leader in the intersection of sports media and sports wagering.
For access to all-new online casino games and sportsbook content, register by visiting www.northstarbets.ca.
Open to Ontario residents, 19 years of age or older. NorthStar Gaming is a licensed and registered online gaming operator by the Alcohol and Gaming Commission of Ontario (AGCO).


- Abstract
Due to COVID 19, personal protective equipment (PPE) is now used in everyday life. Such PPE affects communication and perception. This paper provides an overview of the impact of PPE on Head Related Transfer Functions (HRTFs). Spatial acoustic effects of common PPE on human hearing can be documented to improve and inform field worker safety and communication. After a general description of the measurement process and required tools, we focus on a few methods which contribute significantly to the accuracy and analysis of PPE-based HRTF data. The dedicated setup allows measuring a full 360 degree map in automated fashion. It includes a special ring setup with 25 speakers, and a precise turn table that is used to adjust the angle of the device under test with respect to the ring. Binaural measurements were performed on a set of common PPE items on a Head And Torso Simulator (HATS) system, including hard hats, safety glasses, hearing protection, and various face masks. An overview of the data is presented.


A lot of times a company rushes to court asking the judge to stop a former employee or his new employer from using the company’s confidential information or soliciting its customers based on the agreements that the former employee had signed with the company.
It is a well-known fact that when the economy improves, employee mobility rises as well. The most valuable employees – those with a specialized skill set
Generally, Texas allows non-compete agreements between employers and employees as long as they are reasonable in scope, geographic area, and term, and meet a few other
A recent case from a Texas Court of Appeals demonstrates that the Texas non-compete statute applies not only to the employment agreements or sale of
While we patiently wait for a sequel to Dodgeball: A True Underdog Story to come out, a similar saga involving competing gym/spa establishments has been unfolding in Houston, Texas


Abstract
The authors studied 33 cases of adverse side effects possibly related to ocular 10% phenylephrine application drawn from case reports submitted to the National Registry of Drug-Induced Ocular Side Effects. These cases included 15 myocardial infarcts, 11 of which were terminal; in 7 additional cases cardiopulmonary resuscitation was necessary, and the remainder primarily included marked increase of blood pressure. It is concluded that if these responses were drug-related, predisposing factors may have included overdosage of the drug, cardiac disease, advanced age, and drug interactions. Myocardial infarcts occurred primarily in older patients with preexisting cardiac disease. This type of population would have an increased incidence of myocardial infarcts regardless of topical ocular medication. The authors' results did not prove a positive correlation between 10% phenylephrine and myocardial infarcts. However, based on these case reports, the amount of drug delivered, and the drug's known cardiovascular effects, they formulated possible guidelines for the clinical use of topical ocular 10% phenylephrine. To date, no significant adverse effects have been reported to the National Registry of Drug-Induced Ocular Side Effects with the ophthalmic use of 2.5% phenylephrine hydrochloride. Six additional cases of adverse reactions related to 10% phenylepinephrine have come into the Registry since this article was written.
ASJC Scopus subject areas Ophthalmology


Newspapers as Coasian Firms
| Peter Klein |
The hunter-gatherer model of journalism is no longer sufficient. Citizens can do their own hunting and gathering on the Internet. What they need is somebody to add value to that information by processing it — digesting it, organizing it, making it usable.
This is why we still need newspapers — or something like them. Ronald Coase, the British economist, once asked why we need business firms. Why can’t all their activities be coordinated by individuals contracting with one another instead of working in a bureaucratic, command-and-control environment? The answer, he said, is transaction costs. If a manager had to negotiate with a free-lancer for every task, the cost in time would be unbearably high.
Searching for information on the Internet involves something like transaction costs because we have so many varied sources to evaluate. We need somebody we trust to organize them for us. That can be the task of the new journalism.
That’s from the retirement speech of UNC journalism professor


MHCLG phoneboxes permitted development consultation response
This is my response to MHCLG’s consultation on the proposal to remove planning permitted development rights for public call boxes and for deemed consent for single-sided advertisements on public call boxes.
Question 1.21: Do you agree that the permitted development right for public call boxes (telephone kiosks) should be removed?
Yes.
I campaign against the installation of BT InLinkUK kiosks across the UK, many of which have sought, and some of which have been granted, planning permission through telecoms prior approval/permitted development applications. I track the progress of many of these applications and appeals against refusal on my website. I am aware of and broadly opposed to similar kiosks from other operators such as New World Payphones and Euro Payphone (Pulse).
These operators are using the current permitted development rights to perform a literal landgrab of pavement space for devices and purposes that are far outside that originally envisaged for simple public telephony. Ofcom’s universal service obligation for public call boxes was last updated in 2005, two years before the iPhone, the first real smartphone in the modern sense, was launched. While the GPDO was last revised much more recently in 2015, it has nonetheless not kept up to date with developments in technology, business and social custom.
The current generation of digital kiosks that are using permitted development rights incorporate a range of features and technologies that are radically different from traditional phone boxes. Yet as long as they retain the ability to make telephone calls they are permitted in principle. This “feature creep” creates a range of new opportunities for street kiosks, but also a range of new concerns regarding them including issues around privacy and surveillance, as well as more traditional planning matters, which require careful local consideration rather than automatic permission in principle.
Permitted development rights for kiosks are undermining councils’ efforts to declutter pavements both physically and visually, to make them safe, accessible and pleasant for people on foot. While the current regulation permits councils to refuse permission on siting and appearance grounds in each individual case, it does not permit them to take into account the cumulative impact of fleets of kiosks from multiple operators or even from a single operator. Councils should not be effectively forced to play whack-a-mole with applications using telecoms prior approval applications when they really want to refuse such applications in principle.
Westminster City Council writes:
Over the last two years Westminster council has already rejected 170 applications for new telephone kiosks which the authority believes serve little purpose beyond creating advertising space in high profile locations like Oxford Street, Victoria Street, Edgware Road and Baker Street. If all of the applications had been approved there would be one phone box every 15 metres along Edgware Road.
Thus, new business models for these kiosks have transformed them from “phones with adverts” to “adverts (and many other things) with phones”. For example, InLink kiosks permit free phone calls and therefore principally rely on their advertising screens to generate revenue. This has led to unintended consequences such as the situation in Tower Hamlets, where BT disabled all calls from InLink kiosks to mobile phones on the advice of the police and council after 20,000 drug deals were arranged on just five InLink kiosks in 15 weeks.
The fans required to cool the computer equipment and screens inside modern digital kiosks also have the potential to create a significant noise nuisance, especially during hot weather where the fan speeds are automatically increased to compensate. This is a material planning consideration that cannot currently be taken into account in decisions due to permitted development rights that limit local control to siting and appearance matters. There is no scope within the current regulation for a council to require a noise impact assessment and management plan to be submitted with a telecoms prior approval application.
New generation kiosks typically include a range of surveillance features or surveillance potential that requires councils to consider privacy as an amenity matter in a similar way to how overlooking has traditionally been viewed. For example, InLink kiosks incorporate three cameras facing onto the street, a feature that is unprecedented in the traditional phone box. The kiosks’ high-speed network connection creates the possibility that they could be used for a range of realtime or recorded CCTV applications such as remote monitoring, automatic number plate recognition (ANPR), facial recognition (as is currently being trialled by police forces in London and Cardiff) and similar applications. The wifi services in such kiosks can also be used as a surveillance system to monitor people’s mobile phones in passing even if they are not connected to that operator’s network. Transport for London trialled a system of this kind on the Tube in London in 2016, allowing them to reconstruct 42 million detailed journeys by over 5.6 million people during the course of a single month. InLink has said that they are interested in using their kiosks to track pedestrian and vehicle movement. While such applications may have benefits, depending on their implementation they also have significant potential drawbacks. Local councils should be empowered to decide what forms of street-based surveillance are acceptable in principle and in each individual case. Removing permitted development rights would enable that.
Removing permitted development rights for public call boxes will enable councils to make policies for this kind of digital/physical infrastructure in their local plans which reflects the local context and priorities and which has the potential to be more flexible than one-size-fits-all national regulation. For example, local council responses to the InLink system range from those that are enthusiastic to those that are bitterly opposed, with some gradations in between. While the merits, and indeed the necessity, of such systems can be debated, what is not in debate is that there is no broad consensus at local, regional or national level that they are necessary or desirable. It is undeniable that the new generation of digital kiosks are substantially a different kind of thing to the traditional phone box. While they retain a phone feature, their multiplicity of features brings new and often complex concerns along with every potential benefit.
This situation demands that national government does what it is proposing to do: leave these decisions in local hands, enabling councils to consider the full range of material considerations in their determinations. Public space belongs to the public, not to telecoms, technology and advertising companies. Local people, through their elected representative councils, are best placed to decide how their public space is best used and what amenities and technologies should be permitted there for the public benefit.
Question 1.22: Do you agree that deemed consent which allows an advertisement to be placed on a single side of a telephone kiosk should be removed?
Yes.
There is no national strategic requirement for street advertising of any kind. Therefore, the acceptability in principle and practice of any advertising, including that which this consultation proposes to remove deemed consent for, should be a matter for the local planning authority.
As the current provision specifically excludes illuminated advertisements, it is unlikely to have any significant impact on the new generation of internet-connected kiosks with illuminated digital advertising screens. However, there is scope within the current deemed consent provision for operators to install non-illuminated digital e-ink screens. Removing deemed consent here would allow local planning authorities to control such advertising according to their local contexts and priorities.


Information for AlaskaAlaska has established cleanup standards of 0.1ug/100 cm²but they only apply to illegal methamphetamine manufacturing sites. If items are visibly stained they must be removed and disposed of, however all non-porous items may be decontaminated using hot water and detergent cleaning of at least 3 times. Note that wood and granite countertops are considered porous and must be removed and replaced. All floor/wall fans and exhaust vents over stoves/ranges must be removed and disposed of. The ventilation system may be decontaminated. It is recommended that ADEC Qualified Person or Qualified Third Party conduct the verification sampling to clear the property however this is not required, the verification sampling can be performed by anyone including the homeowner. The pre-testing can be completed by the decontamination contractor or home owner, but pre-testing is not required. If the verification samples are not successful in achieving acceptable levels encapsulation of paintable surfaces with two coats of oil based paint or Kilz is recommended. Note that spray on ceiling surfaces that are not removed must be encapsulated by spray painting with two coats of oil-based paint. Meth lab properties are placed on the ADEC list and remain there for five years after cleanup of the site was performed.


The dieting strategy known as intermittent fasting involves alternating eating times with periods in which one does not consume any food. According to some studies, practicing intermittent fasting might help people lose weight and lower their chances of developing certain chronic diseases, including heart disease, diabetes, and Alzheimer's.
In the case of intermittent fasting, you may be curious about whether or not you are permitted to consume coffee while you are on a fast. This article discusses whether can you drink coffee while fasting and may be consumed during fasting periods while practicing intermittent fasting.
It is doubtful that drinking reasonable amounts of liquids that are very low in calories or have no calories while you are fasting would impair your fast in any meaningful way.
Beverages such as espresso and black coffee fall under this category.
A single black coffee serving roughly 240 milliliters has about three calories and trace quantities of protein, fat, and minerals. There aren't enough nutrients in one to two cups (240–470 ml) of black coffee for the majority of people to experience a substantial shift in their metabolism that would cause them to break their fast.
It has been suggested that drinking coffee might help curb your hunger, making it more manageable to go without food for an extended period. Despite this, the allegation has not been verified by scientific research. Consuming coffee in moderation won't severely break your fasting schedule, even if you do it intermittently. Just ensure it stays black and does not get any other components.
Inflammation that persists over time is a primary contributor to the development of many diseases. According to some studies, drinking coffee and practicing intermittent fasting can help decrease inflammation.
Lower risk of metabolic syndrome, an inflammatory condition marked by high blood pressure, excess body fat, high cholesterol, and elevated blood sugar levels, has been linked to drinking more coffee, according to the findings of some studies. Metabolic syndrome is characterized by these symptoms: high blood pressure, excess body fat, high cholesterol, and elevated blood sugar levels.
Studies have also linked drinking coffee to a reduced risk of developing type 2 diabetes. In addition, research suggests that drinking coffee up to three times a day (710 ml total) is related to a 19 percent lower risk of dying from cardiovascular disease.
Its promise to boost brain health and guard against age-related neurological illnesses is one of the primary reasons intermittent fasting has recently gained such a meteoric rise in popularity.
It's interesting that coffee contributes to and enhances many of these advantages. Consuming coffee consistently, like intermittent fasting, is connected with a decreased risk of cognitive decline and Alzheimer's disease, and Parkinson's disease. While fasting, your body converts fat into energy from ketones, which is connected to increased brain performance. The preliminary findings of this research suggest that the caffeine in coffee may also enhance the creation of ketones. In addition, intermittent fasting may increase autophagy, which benefits brain function. A healthy cell is replaced with a damaged one through autophagy, the body's repair process. According to the findings of several studies, it may protect against the mental deterioration that comes with aging. In addition, research on mice linked coffee consumption to a significant increase in autophagy. As a result, including coffee in your intermittent fasting routine in little amounts might be highly beneficial.
Even though coffee by itself probably won't cause you to break your fast, adding things to it may.
Keep your calorie intake between 50 and 75 throughout each fasting window, as several credible health and media institutions recommend. You won't have to worry about breaking your fast. However, no evidence from the scientific community supports these statements.
Instead, when fasting, you should try to ingest as few calories as possible.
During your fasting periods, you should avoid consuming things like lattes, cappuccinos, and other coffee beverages that are either heavy in calories or sweetened.
In the case that you must add something to your coffee, a teaspoon or five milliliters of heavy cream or five milliliters of coconut oil are good options since neither will significantly change your blood sugar levels or overall calorie intake. However, drinking coffee black is the optimal choice.
About 100 mg of caffeine may be found in a single serving of coffee, equal to 240 milliliters. Consuming excessive caffeine from coffee can cause adverse effects such as heart palpitations and momentary spikes in blood pressure. According to one study, high coffee consumption, defined as up to 13 cups (3.1 liters) per day, led to higher fasting insulin levels, indicating a temporary loss in insulin sensitivity.
You should limit your coffee consumption to a minimum if you wish to enhance your fasting insulin levels, boost your body's sensitivity to insulin, and use intermittent fasting as part of your treatment plan. Additionally, consuming an excessive amount of caffeine may negatively impact the quality of your sleep. A lack of quality sleep can hurt your metabolic health over time, which may nullify the positive effects of intermittent fasting.
According to most studies, an amount of caffeine equal to or less than 400 milligrams per day is probably safe for most people. In terms of volume, this amounts to roughly three to four cups (945 to 710 ml) per day.
Ultimately, whether or not one chooses to consume coffee while fasting is a matter of personal taste. There is no use, in the beginning, to drink coffee if you are not already a fan of the beverage or do not presently consume it. A diet abundant in foods that are not processed and high in nutrients can provide many of the same benefits to one's health.
If, on the other hand, drinking a steaming cup of coffee during your fast helps you feel more comfortable, there is no need to break your fast. Just keep in mind to consume in moderation and stay away from adding other components. If you discover that you drink too much coffee or have difficulties sleeping, you might want to reduce back and concentrate all of your energy on the intermittent fasting method instead.
When restricting your caloric intake, you are permitted to consume black coffee in limited quantities since it has a meager calorie count and is not likely to cause you to break your fast. Coffee consumption has been shown to augment the health advantages of intermittent fasting, which include reducing inflammatory responses and improving cognitive performance.
Nevertheless, you want to avoid additives that are heavy in calories. Be mindful of how much you consume since consuming more than your body needs might harm your health. now you know if can you drink coffee while fasting or not


The Cresskill, N.J.-based company is developing a sirolimus-eluting collagen implant for patients with end-stage renal disease. The bioresorbable drug-delivery system is designed to keep open a portal of entry into a patient’s vascular system for hemodialysis.
Roughly 70% of ESRD patients depend on hemodialysis, according to Vascular Therapies, and patients traditionally undergo treatment three times a week.
To prepare a patient’s body for dialysis, a surgeon connects an artery and a vein in the forearm or upper arm, establishing a “vascular anastomosis” – or an arteriovenous fistula. Once the fistula is created and blood begins to flow, it begins to widen in a process known as fistula maturation. This process is essential to successfully treating patients using hemodialysis.
But this approach brings about its own set of problems, Vascular Therapies noted. Over time, cells surrounding the fistula begin to rapidly multiply, causing tissue growth. This process narrows the vascular access port, rendering the fistula useless.
Until a fistula is fully mature, patients undergo dialysis using a catheter. Vascular Therapies is investigating whether it can help limit the time patients spend using catheters and lessen the fistula maturation failure rate using its localized drug-delivery implant.
“Reducing the time between surgery and when the fistula can be cannulated successfully for dialysis and minimizing the need for additional, supplementary interventions to help maintain fistula functionality are extremely clinically relevant outcomes. Achieving these endpoints are expected to reduce catheter dwell time and catheter dependence – a much-desired outcome with important implications for patients, dialysis providers and payors,” the company wrote on its website.


This review of the most effective oral premedication in reducing pain in adults after nonsurgical root canal therapy including 16 studies. While a premedication of choice is suggested most outcomes are only supported by very low quality evidence.[read the full story...]
This review of the efficacy of non-steroidal anti-inflammatory drugs (NSAIDs) as premedication on the success of inferior alveolar nerve block includes 13 RCTs suggesting NSAIDs have a positive impact on success.[read the full story...]


The presence of missing values complicates statistical analyses. In design of experiments, missing values are particularly problematic when constructing optimal designs, as it is not known which values are missing at the design stage. When data are missing at random it is possible to incorporate this information into the optimality criterion that is used to find designs; Imhof, Song and Wong (2002) develop such a framework. However, when data are not missing at random this framework can lead to inefficient designs. We investigate and address the specific challenges that not missing at random values present when finding optimal designs for linear regression models. We show that the optimality criteria will depend on model parameters that traditionally do not affect the design, such as regression coefficients and the residual variance. We also develop a framework that improves efficiency of designs over those found assuming values are missing at random.


In Pharma Brand is Everything - Can Blockchain Help You Maintain it? Blockchain and Brand Protection - ServBlock
Theoretically and practically, blockchain technology has legal implications to combat the proliferation of fake drugs. Automated drug tracking systems can help to prevent the spread of counterfeit medicines by tracking each package's unique coding. In the pharmacy, blockchain technology could create a reliable system of legislative safeguard to ensure the delivery and tracking of medicinal products. Moreover, such a system might allow for significantly simplifying pharmaceutical product audits and controls. Here are some studies which reveal legal benefits of blockchain technology in the pharmaceutical industry.
ServBlock utilizes the R3 Corda next-gen, open-source blockchain platform explicitly designed with highly regulated institutions in mind. 1. Counterfeit Drug Elimination
One previous study states that huge pharmaceutical giants such as Pfizer and Genentech collectively have a market valuation of more than
$300 billion and announced the blockchain project. The Quorum platform, based on Ethereum, forms the basis for it, and the reason for developing a blockchain is to prevent counterfeit goods' access to the supply chain. In addition, the new Ethereum system will let pharmaceutical companies identify poor-quality drugs before they reach the supply chain. 2. Trust and Transparency
Another study reveals the legal benefit of blockchain technology, which makes it possible to share data without
compromising users' right to privacy, and pharmacists can use blockchain to verify the provenance of a medication. By confirming the source of medicinal supplies, blockchain could offer pharmacists adequate patient safety assurance. Additionally, Blockchain technology also enables the creation of new decisions to manage the movement of medications, particularly in terms of temperature regime compliance that must be followed during drug transfer. Because of this, in January of 2018, the pharmaceutical giants Pfizer, Amgen, and Sanofi launched a blockchain platform for clinical trials with the goal of reducing the cost of creating and testing new pharmaceuticals.
Even though blockchain technology's investment is minimal, it's still a big deal, rapidly increasing in size. There are many examples of blockchain platforms used by IBM and Microsoft in their customer service systems. Additionally, many large corporations are actively pursuing blockchain technology and how it might benefit their business. For example, Walmart Paying for products online and accepts payments from vendors and uses blockchain technology to improve their products and customer service.
3. Better Clinical Research Quality
Benchoufi and Ravaud have provided an explanation of how blockchain technology can be used to improve clinical research quality. Healthcare data is very valuable and is susceptible to numerous forms of attacks. MedShare is another concept that aims to leverage blockchain technology in the health care industry to transmit medical data from one institution to another in a trusted environment. Blockchain is now the most reliable method for providing cyber security in the 21st century, and there have been no known vulnerabilities discovered in it. Because it is meant to prevent any one individual from changing the data and transactions, blockchain has the potential to boost levels of trust and assist in removing the bias that is present in conventional supply chain systems.
Another implication of blockchain technology is that if barcode-tagged medicines are scanned and placed into secure digital blocks whenever they change hands, blockchain might provide substantial advantages. Even patients at the other end of the supply chain might access this real-time information at any time. According to researchers, Digital technology has been one of the significant drives shaping our businesses and lifestyles. Our healthcare supply chain could be significantly affected by the use of blockchain technology. As blockchain is integrated into the mainstream healthcare supply chain, it is critical that all stakeholders, including pharmacies, understand the possible consequences and be strategically positioned to evaluate and potentially accept "fast-moving" commercial applications.
References
Pashkov, V., & Soloviov, O. (n.d.).
Legal implementation of blockchain technology in pharmacy. https://doi.org/10.1051/shsconf/20196801027
Haq, I., & Muselemu, O. (2018). Blockchain Technology in Pharmaceutical Industry to Prevent Counterfeit Drugs.
International Journal of Computer Applications, 180, 8–12. https://doi.org/10.5120/ijca2018916579


The Audit Analytics Accounting Quality + Risk Matrix (AQRM) makes it easy to identify accounting, audit, and governance red flags for public companies. This blog series breaks down the risks associated with specific firm-level events included in the AQRM.
Misstating financial statements is a significant accounting quality red flag.
Unreliable financial statements reduce stakeholder confidence in companies and the ability of their control environment to prevent or detect errors. Misstatements also expose companies to increased shareholder litigation and regulatory risks.
A report by professor Susan Scholz and the Center for Audit Quality (CAQ) found that “the average stock price reaction to restatements was -1.5%.” Returns were even more negative (-2.3%) for companies with Item 4.02 restatements.
Big R restatements, or non-reliance restatements, are corrections of misstatements that are disclosed through the issuance of Item 4.02 on Form 8-K. Big R restatements are the most material restatements and are often accompanied by an ineffective internal control assessment. They also require the reissuance of previously issued financial statements to correct the misstatement.
In addition to negative returns, reissuing financial statements can be costly. A paper by Her, et. al. found that “the presence of restatements leads to higher audit fees in a subsequent period.”
Further, a paper by Chakravarthy and Rajgopal found that, on average, companies take 2.2 actions to repair reputational damage post-restatement. These include improving governance, firing senior leadership, and improving internal controls. This compares to just .31 actions, on average, in pre-restatement periods. These additional actions have significant costs for a company.
Little r restatements, or revision restatements, are corrections of misstatements that are disclosed without reissuing previously issued financial statements. Instead, prior periods are revised in the next financial report. Though not as material, Scholz found that little r restatements result in -0.6% returns.
Adjustments are corrections that do not result in impacts to previous periods. Instead, misstatements are corrected in the current period. Less research is available to determine the market reaction to adjustments. However, companies that are required to make an adjustment to their financial statements also face challenges with their control environment and potential costs to strengthen their control environment.
Kraft Heinz Co. [KHC] has disclosed several restatements and adjustments over the past few years, including restatements related to revenue recognition. Scholz found that restatements involving revenue recognition saw, on average, -4.0% returns.
Material, negligent, or fraudulent misstatements can lead to shareholder litigation and regulatory action.
BorgWarner’s [BWA] 2018 Big R restatement resulted in both. In August 2020, the SEC issued an Accounting and Auditing Enforcement Release (AAER) related to BorgWarner’s accounting for incurred but not reported (IBNR) asbestos claims from 2012 to 2016. In December 2020, shareholders filed a derivative lawsuit for the same issue. BorgWarner was ordered to pay $950,000 related to the SEC’s AAER while the derivative suit was dismissed in April.
The Audit Analytics Accounting Quality + Risk Matrix (AQRM) can be used to monitor, compare, and evaluate the severity of company misstatements along with many other “red flag” disclosures. For more information, please contact us.
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This event has passed. The AMR Challenge Launch Event September 25, 2018 @ 6:00 pm - 9:00 pm
The AMR Challenge encourages global leaders to make formal commitments that further progress against antimicrobial resistance. Your efforts could contribute to solutions that protect humans, animals, and the environment from this global threat.
The first batch of commitments will be unveiled at a United Nations (UN) General Assembly side event on September 25, and will commence a “commitment year” that invites organizations worldwide to participate.
Attendees include Alison Haight, CARB-X Director of Finance


Oh, what joy for those whose disobedience is forgiven, whose sin is put out of sight! Yes, what joy for those whose record the Lord has cleared of guilt, whose lives are lived in complete honesty! When I refused to confess my sin, my body wasted away, and I groaned all day long. Day and night your hand of discipline was heavy on me. My strength evaporated like water in the summer heat. Finally, I confessed all my sins to you and stopped trying to hide my guilt. I said to myself, "I will confess my rebellion to the Lord." And you forgave me! All my guilt is gone. Psalm 32:1-5
I'm not particularly eager to brag, but I am a hide-and-seek grandmaster who can go undetected by his pursuers. For instance, when my kids were younger, we were engaged in an intense game, and it was my turn to get lost. So, into the closet I went, wedged between a vacuum cleaner, ironing board, and some other clutter. I twisted my body into a pretzel, placed a jacket over me, and waited, and waited, and waited some more.
Being a sleep-deprived father of three children , two of which where toddlers, I nodded off while waiting for my kids to find me. Eventually, I woke up to the feelings of not only numb arms but pins and needles in my legs. I dragged myself out of the closet, with every muscle in my body aching and need of ibuprofen. Little did I know I had been asleep for two hours. My kids got distracted in their search, had snack time, and then their mom put them down for their nap.
I learned a valuable lesson that day: hiding hurts. In today's passage, we get a glimpse into the damage hidden sin causes our hearts. The author's body wasted away groaning all day long. His strength disappeared as he attempted to carry the burden he was feeling. He was weak, miserable, and stricken with grief.
Rather than confession, we often engage in sin management. We rationalize, justify and try to explain away to manage the unmanageable. When there is sin in our lives, we want nothing more than to be left alone and do everything possible to hide our struggles. Sadly, hiding not only erodes our relationship with God but also damages our relationship with others. We go crazy attempting to keep up this charade. We distance ourselves. We grow defensive. This juggling act can only go on for so long until one of the balls finally drops. If God didn't design our hearts and souls to bear sin, how do we reconcile this with our desire to manage it?
Our lives depend on getting found. There is no healing in hiding. To come out of hiding means to stop trying to cover our faults and sins. Only when we ask God to forgive our sins will we experience absolute joy, relief, and freedom from our guilt. Repentance is a statement of fact and an acceptance of responsibility. It requires throwing ourselves before God and asking for His already promised and already demonstrated mercy. What will it take for us to stop hiding our brokenness from God and allow repentance to rise? Where are you hiding your brokenness? How is this hiding influencing your relationships and your intimacy with God?
Prayer: Father God, for far too long, I have refused to be honest with the places in my heart where disobedience reigns. The weight of this burden has stunted my growth and staled my pursuit of You. Let today be the day I come out of hiding. May I stop excusing or justifying my behavior and finally be honest about my actions. Thank you for covering my sin and extending the mercy I do not deserve. In Jesus’ name, Amen.


FSP has been providing support to one of the largest prime construction contractors in the UK. The Challenge
In order for any construction company to remain competitive, cost efficiency is a key objective in day-to-day operations. This can sometimes be at odds with the increased threat landscape and the rising costs of cyber security solutions. With the increased demand for cyber security within construction contracts, information security has become a significant consideration within the construction industry.
The Solution
The company’s Information Security team wanted support to get better buy in from senior management, to articulate the real risks to the business and improve overall InfoSec maturity.
Using our experienced team, we were able to support strategy creation, provide risk articulation, deliver end-to-end projects and forecast budgets for ongoing Information Security maturation.
THE BENEFITS These activities have been critical in transforming Information Security from being viewed as an overhead to a key enabler allowing for new contracts to be tendered for. This partnership continues to deliver expert advisory services, on a retained basis, ensuring that support is always available when it is needed most. The breadth of this service means that they can get a blend of support from experienced CISOs and Principal consultants, to deeply technical penetration testers or security engineers.